Heated hose for ResMed S9 or not?

[heavybreathing]

Hi everyone! I am brand new here (first post, yea!), and have my first question.

I got my prescription for a CPAP (AHI during REM over 90, and over 40 overall!) and now it is time to dance the DME dance.

My DME wants to give me an old ResMed S8 Escape II, and I would prefer the S9 Elite. We'll see how it goes. So far, they have tried some of the typical DME lies well documented in these forums.

Anyways, even if I can get the S9 from them (which, by the way, they claim is not as good, because it is a new "untested" model!), they want to give me the non-heated hose.

I am trying to decide if I really want the heated hose or not (assuming I can get them to give me the S9).

Here's what I'm thinking:

Pro's for the heated hose:
1. I had rainout during my titration study. But I think it was because the lab turned the heated humidifier up too high. Once they turned it down, I did not experience rainout. The test was done with a high-end lab RedMed machine without a heated hose. So it's a bit unclear if I would experience rainout at home as well, but I did experience it during the test.
2. If I get a regular non-heated hose, and I get rainout, I'm not sure if my HMO will buy me a heated hose immediately, or make me wait until their scheduled hose replacement (probably quite a few months). Anyone know?
3. My home is currently without any heat, and so it probably drops down into the high-50's (F) inside at night. If I recall my science correctly, the lower the ambient temperature, the more likely rainout can happen. I'm not sure, though, if indoor ambient temperatures in the high-50's (F) are significant or not.
4. We get a fair amount of indoor mold. Will a heated hose dry out faster in the morning to help inhibit mold growth?

Con's for the heated hose:
1. If the non-heated hose works, it's one less thing that can break or stop working (and it seems like the heated ones break more often according to these forums).
2. I'm a bit concerned about possible EMF exposure from the heated hose. That's a long period of time every day to have extremely close contact with an electrical device. Not a deal breaker for me, but if I don't need it, I would prefer to do without the extra possible EMF exposure.
3. Hassle. The DME claims it is a different code for the heated hose. From what I have read here, that is pure balarky, but it may take some unenjoyable work to get them to give me a heated hose.
4. Cost. If it's not needed, no reason to make the HMO pay more than is needed to get me the best therapy possible.

The other issue, and I'm not sure if this would be a pro or con, is that we live in a fairly humid environment (but not super humid). I would guess that because of this, I will set the humidifier lower than some people in other climates. I would guess that would lower the chance of rainout (but I really don't know). But then again, because of the higher level of ambient humidity, maybe rainout is more likely? I'm interested in what others have to say on this.

So what do people think - heated hose for the RedMed S9, or the non-heated skinny hose, or something else entirely?

Thanks in advance!

[msradar65]

I am a newbie. its been not quite two months. I have S9 autoset and I use the climateline heated hose. I have never had rainout.
I would go with the heated hose. You can always buy the hose yourself. I bought my back up hose off ebay.

I would also go for the S9 autoset if you can. More bang for the buck. I would also shop around all the DMEs that accept your insurance and see what they offer.

I chose my DME by the machine they offer as standard to CPAP patients. Mine offers the autoset. They at least have the right reason for offering it. More patient comfort. More flexibility if you must make a change and you can do titration at home if a change is needed.

It also helps that the RT at my DME has been on CPAP for 10 yrs himself. So he really knows his stuff. He also has tried most of the products on the market himself.

[Big S]

I went for the heated hose. With it, I could select the temperature of the humid air at the mask. For me it was like choosing between standing on a beach in Hawaii and feeling the trades hitting me in the face or exiting my front door in high humidity in the middle of August in Dayton Ohio. Durability may be the greatest issue but I think it's worth the gamble.

[chunkyfrog]

Good luck getting the Elite. You may have go elsewhere to get the machine of your choice; but it's worth it.
Not all DME's are creeps--just most (it seems)
I love the Climateline tubing, but it is fragile.
I put some vetwrap on to help reinforce the weak parts.

[msradar65]

I have hose cover on my climateline. I also use those velcro hose clips. I have my hose clipped to the bottom of my mattress so I can't pull the whole machine off the night stand.

[idamtnboy]

Go for the hose! Another thing the heated hose gives you is it enables the automatic temperature/humidity control option. Set the air temp and the machine adjusts humidity automatically at a comfortable 80% RH.

If necessary, shop around for a DME. The doc can't force you to go to a specific DME. Hopefully, you have more than one in your area. And then of course, there's always cpap.com. I've never dealt with them but undoubtedly you've read the many positive comments by others here.

[sleepyb]

Go for the heated hose. Especially if your room is in the 50's Cold wet air blowing on your face all night sucks. Yes my DME doesn't sell S9's so I went with the respironics and had to buy the heated hose separately But it was worth it.

[kempo]

If you are going to get the s9 demand to have the climateline hose. I used my s9 auto for 4 months before I bought the climateline hose. I wish I had started off with it. It works great.

[heavybreathing]

Wow! This forum is GREAT! I can't believe all these great responses so far! Thank you to everyone who has replied, and keep the replies coming! I learn something new with each post from you all!

There seems to be a consensus, made especially clear in SleepyB's reply, that without the heated tube, not only is rainout a risk, but the inhaled CPAP air will be cold. I was under the impression that the heated humidifier would heat the air and therefore the heated tube was just to help reduce rainout. Why isn't the heated humidifier enough?

Also, I am very surprised by the overwhelming consensus (so far, at least) regarding getting the heated hose. I was actually leaning against it. It just seemed like another possible point of failure, and possible EMF exposure. After reading the posts so far, I am now strongly leaning in favor of it.

Some of the supporters are even from posters who I think have posted durability issues with the heated hoses. I infer from that data that the heated hose is so good that even with durability issues, it is a valuable addition to a CPAP setup.

BTW, the DME was trying to convince me that the heated hose was unneeded and that any CPAP can be "adjusted" or "tweaked" to avoid rainout.

[Slartybartfast]

[snip]

BTW, the DME was trying to convince me that the heated hose was unneeded and that any CPAP can be "adjusted" or "tweaked" to avoid rainout.

Well, yes it can, but it's more convenient to just let the machine handle that. The Climateline hose is well worth the $50 or so it costs. I bought mine out of pocket and, other than getting an odd error message one day when I came home from work and it was over 100 degrees in my room, I've not had any problems, or a repeat of the error message. I think it must have been from the heat that day.

Re: the DME, just tell the Dude that you want an S9 Autoset with Climateline hose and mask of your choice. If they persist, thank them and walk out. The sound you will hear will be that of the Dude's jaw hitting the floor. Not all DMEs are like that. A friend who lives in a little town in Kansas heard me gushing about my S9 Autoset and he got off his backside and had another sleep study done. He was one of the guys you run into who poo-pooh CPAP because they tried it years ago and "it didn't work for [him]." But he said he'd give it another try. His sleep doc wrote him a prescription for CPAP which he took to the nearest DME and he walked out with a brand new S9 Autoset without any hassle.

Something many DMEs don't seem to get is that YOU're the customer. You're not a captive, and you're not stupid. You can vote with your feet. If they lie to you, or play games, just tell them you're going elsewhere, and do so.

[joeattardi]

Keep up the fight! I was in your exact same situation - started out with an S8 Escape II, and then the nice folks on this forum helped me through fighting my insurance/DME to get an S9 AutoSet - it's worth it!

[sleeplessinaz]

I would also go for the S9 autoset if you can---that is the better than the ELITE. I have the ELITE and am hoping to be getting the S9 soon--hopefully tomorrow!! I am going to ask them for the heated hose as well--it sounds like a good idea to get one up front. Who knows what hassles I will have as well but as long as you are armed with knowledge --you can get what you need from them. Good Luck in whatever you decide!!

Carrie

[heavybreathing]

Interesting that people are recommending the S9 Autoset. I was going to consider myself fortunate if I could get the S9 Escape, and real fortunate if I could get the S9 Elite. I wasn't going to try for the Autoset because the doc wrote the prescription for a fixed pressure and a fixed EPR value. I figured that getting an S9 Autoset with that prescription would be impossible. Was I wrong? Could I actually insist on an S9 Autoset?

And on the original topic of this thread, it is amazing that no one has recommended against the heated hose (at least so far). That is an impressive data point.

I called the insurance company, and they can switch the authorization to a different DME if this one is unwilling to do what is best for me. From what I can tell, the insurance simply authorized certain CPT codes (and stated some are for rental and some are for purchase). They did not specify what brands/models the DME should provide with those codes.

I welcome all tips. Thanks! You guys/gals are great!

[jmelby]

From what I can tell, the insurance simply authorized certain CPT codes (and stated some are for rental and some are for purchase). They did not specify what brands/models the DME should provide with those codes.

Yep... exactly... and that is why the DME will try to give you the cheapest stuff possible... S8 Escape, standard hose. They get reimbursed the same whether you get the more expensive equipment or the cheapest. So, it is in their interest to give you cheapest and pocket the difference. Not all DMEs are like this, though... mine is associated with a local hospital and they always give people the S9 AutoSet... set it to CPAP mode if they don't have a prescription for APAP, but it allows them to switch to APAP if they need to if a patient's pressure need to be re-titrated.

Regarding the climateline hose... definitely get it. I have had it since the S9 first came out and have NEVER had rainout with it--though I did with my S8 + standard hose before that. Sure, there are ways to compensate by turning down the humidifier, getting a hose cover, but it is hard to get those things right every night given fluctuations in humidity in the air (and I hate hose covers--they weigh it down and I feel like I'm being pulled off the bed).

[tschultz]

Rainout is something I too am worried about and speaking with a few friends on CPAP they have had this problem at one time or another. From my perspective the heated hose is the best option and the problem is one of simple physics; if the humidified air is at one temperature and comes in contact with a temperature below the dewpoint for that relative humidity/temperature then you will get condensation. By heating the hose there is no way for the air to come in contact with a low enough temperature throughout the whole system.

I don't know if the climate control hose is much heavier but for a moderate cost it does seem to be a good choice and should in theory eliminate any chance of rain-out.